Health Research Methodology lecture notes By: Tilahun Nigatu January 2007

Contents 1. Introduction to Health research 2. Identifying and prioritizing topics for research 3. Analysis and statement of the problem 4. Literature review 5. Formulation of research objectives 6. Methodology 7. Designing a research instrument 8. Referencing styles 9. Preparation of research protocol 10. Application of statistical packages

Introduction to Health Research Key questions: What is a question? What is a problem? What is a research? Why a research is conducted? Who should be involved in research?

Basic questions in health system What are health needs of people? What is the coverage of health interventions? How can we use resources cost-effectively? How can we control environmental factors? Without research answering these questions is unthinkable

Health problems Health problems Health service problems Other Health-related problems A Health research is needed to solve these problems

Health systems research A systematic collection, analysis and interpretation of health and health related data to answer a certain question or to solve a problem

Characteristics of research Demands clear statement of the problem Requires clear objectives & methods Builds on existing data Involves systematic process Have clear vision of outcome

Purposes of health research Basic research: to generate new knowledge and technology Applied research: to facilitate prioritizing, designing and evaluation of interventions Science progresses by falsification rather than verification

Quantitative Vs Qualitative Quantitative research: Tries to quantify things in terms of numbers Has explanatory purpose Qualitative research: Tries to describe things in terms of contexts Has exploratory purpose

Who should be involved in health research? Everyone concerned with the problem under study should get involved Policy makers Managers Health care providers Community But level of participation and type of role depends on level, complexity, and focus of the study

Guidelines for successful research Focus on priority problems Action-oriented Multi-disciplinary Participatory Timely Cost-effective Simple, short-term designs Clear results Honest limitations Expressed implications and recommendations

It is a must It is a must for any research to be: Purposeful Targeted Credible Timely

Basic study steps State the problem (what are the questions?) Devise a plan of action(what will I do?) Implement the plan (how I do it?) Analyze data (what happened?) Interpret data (what does this mean?) Re-examination (is my logic correct? What next?)

2. Identifying and prioritizing topics for research

Identification of a topic A health information is required for: Description of health situation Evaluation of health problems Definition of problem situations

When does a problem situations requires research? When is a perceived discrepancy between reality and expectation When reasons for the discrepancy are unclear When there is more than one possible answer to a question or more than one solution to a problem

How do you think about a research topic? From personal experiences/observations By discussion with community/health workers By contacting researchers/experts on the topic By reading journals/articles’ recommendations From formal advertisement by organizations

Prioritization of a research topic Criteria Relevance Avoidance of duplication Urgency (timeliness) Political acceptability Feasibility of study Application of results Ethical acceptability

Features of a good topic Interesting and able to catch eyes of a reader Short and precise (specific) Related to the general objective of the study

3. Analysis and statement of the problem

1. Analyzing the problem Why we need to analyze a problem? To pool knowledge To clarify the problem and related factors To determine focus and scope of the research

Steps in analyzing a problem Clarify the view points of participants Specify and describe the core problem (nature, distribution, size, intensity) 3. Analyze the problem Write the core problem Think of all possible contributing factors Identify further contributing factors Categorize factors Construct conceptual framework

2. Deciding focus and scope of research Points to consider in deciding include: Usefulness of information to be collected Feasibility of analysis data to be collected Duplication of findings with previous studies

3. Formulating statement of the problem Statement of the problem is the first major section in a research proposal Why is it important to state and define the problem well? Because, It is a foundation for a research It facilitates search of information It justifies why the research should be conducted

Contents of statement of the problem A concise description of nature of the problem: what is it, its magnitude, distribution,severity & consequences Systematic elucidation of why the proposed research should be undertaken Brief description of any attempts to solve the problem in the past-success,failure & challenges Provide a convincing argument that available knowledge is insufficient to solve the problem under study Brief description of the significance of the proposed study: how results will be useful

4. Literature review

What is a literature review? A systematic analysis and interpretation of available information about a topic of study It is an excellent opportunity to develop professional confidence in the field of study

Why do we review literature? (reasons) To know more about a problem To avoid duplication of information To learn the gaps in the arena of study To learn various methods that others used To forecast challenges that might be faced in the conduct of study

What do we review? (Sources) Library (published information) Electronic search engines (internet) Gray literature (Unpublished ones)

How do we write a review of literature? Three steps in writing review of literature Consider your analysis of the problem Organize notes based on factors Decide the order (you have three options) From broader to specific From global to local From past to present

Bias in literature review This is distortion of available information to reflect unreal situation Common types of bias in literature Playing down controversies & differences Restricting to supporting references Drawing far-fetched conclusions from small studies Using rhetoric rather than reasoning

Important tips on literature review Search widely Evaluate relevance of an information to your study Include information directly relevant to your study Mention sources for all bold statements Write a coherent discussion in your own words

Literature review should be In general Literature review should be Adequate Relevant and Critical It must answer the questions: How much is known about a topic? What is not known about the topic? What should be done on what is lacking?

5. Formulation of research objectives

Estimation objectives Association objectives Evaluation objectives Types of objectives Estimation objectives Estimates magnitude of an event Association objectives Analyses factors associated with an event Evaluation objectives Evaluates associations

Categories of objectives General objective: Summarizes what is to be achieved by the study Should be clearly related to the statement of the problem Specific objectives Logically connected parts of the general objective Focus the study on the essentials Direct the design of investigation Orient collection, analysis & interpretation of data

Why should research objectives be developed? It is because research objectives: Focus the study Avoids unnecessary information Facilitates organizing of the study

How should we state objectives? We do have three possible ways: As positive statements As research questions As a hypothesis A hypothesis is a prediction of relationships between one or more factors and the problem under study that can be tested

Criteria for setting research objectives Research objectives should be Focused, each covering a single point Ordered in a logical sequence Realistic and feasible to answer Operational using action-verbs Measurable in terms of outcomes at the end

Action-verbs Vs non-action verbs To determine To compare To verify To calculate To describe To asses To explore To test To establish To identify Non-action verbs To appreciate To understand To show To share To believe to study

In short Objectives must be SMART Specific Measurable Achievable Realistic Time-bound

6. Methodology

Basic questions What is the choice of the study design? What should be the study population? How many study subjects are needed? How should study subjects be selected? How data collection tools be developed? How should data be collected? How the collected data is going to be managed? How data quality will get assured?

Study designs Four major study designs Cross-sectional Case-control Cohort Experimental Selection of the study design depends on the objective of a study

Populations Target population: the population to whom the results would be applied Source population: the population from whom study subjects would be obtained Sampling frame: the list of potential from which the sample is drawn Sample: Subjects who are selected Study subjects: the actual participants of the study

Sample size determinants The study design & sampling method P=the level of the magnitude d=the magnitude the change you want to be able to detect reliably (margin of error) à=how sure you want to be that a change of the magnitude would have occurred by chance (level of significance) 1-ß=how sure you want to be that you will observe a change of magnitude if it did in fact occur (power) Response rate, loss to follow up

Sample size For estimating single mean For estimating single proportion For estimating difference between two means For estimating difference between two proportions Finite population correction

2. Non-probability sampling Sampling techniques Probability sampling Simple random Stratified random Systematic random Cluster sampling Multistage sampling 2. Non-probability sampling Purposive/Judgmental/ Convenience/Reliance/ Consecutive Snow ball

Study variables A variable is a characteristic of a person, object or phenomenon that can take on different values expressed in numbers or categories. Types of variables Dependent/outcome/response variable Used to measure the problem under study 2. Independent/exposure/predictor variable Used to measure determinants of a problem 3. Confounding variable A variable associated with both the exposure and outcome

Types of data Primary data: data that one has collected oneself Better understood by the researcher Usually contains few variables Secondary data: data that has already been collected by somebody else Not well understood by the researcher Very large number of variables

Data collection Two broad categories of data collection Quantitative data collection Qualitative data collection

Quantitative data collection Techniques Interview administered questionnaire Self-administered questionnaire Direct measurement Review of record

Qualitative data collection Techniques Key informant interview In-depth interview Focus group discussions Observations (direct, participant)